COVID-19 transmission in schools and the impact of asymptomatic infections

Sensible Medicine

Sensible Medicine x Vaccine Curious Cross Podcast on the USA vs Denmark, vaccines, etc:

Show notes by Dovid Y Rimmer, Tracy Beth Høeg and Christine Stabell Benn

* Benn, Høeg. Regarding becoming a medical skeptic. Hoeg: anonymous blog - exercise during pregnancy. Benn: Vitamins, sex differences, and vaccines.

* Differences in pandemic response between Denmark v. California - school reopening, masks.

* USA recommends boosters (yearly) for Children, Denmark does not recommend vaccinating children <18 at all for covid..

* Benn: Op-ed recommending gradual herd immunity.

* Høeg, Duriseti, Prasad NEJM letter: Observational data for Covid mortality in vaccinated + boosted population (Source the original study, raw data release in response to letter, and Prasad NEJM letter).

* Chandra & Høeg reanalysis of MMWR study: Differences in Covid-19 between schools mandating masks and not mandating. MMWR did not publish reanalysis, published in Journal of Infection.

* Høeg et al reanalysis of Cowger et al. in NEJM, differences between schools mandating masks and not mandating in Boston, MA.

* Six Clalit Health studies from Israel published in prestigious medical journals - the studies did not release their data or analyses to the public. (What were the points they made that influenced policy decisions, where were they cited, altimetric score. i.e. note that they were effective influencing policy without transparency).

* Childhood vaccination schedules: Denmark 18 doses and USA 50 doses vaccination schedules. Note: differences regarding Influenza, Hep A & B, Varicella, Meningococcal, and Covid-19 which may be added to a yearly schedule. Denmark and Sweden don’t recommend yearly influenza vaccine in non high-risk under 65. 

* Denmark requires benefit for children, Finland allows societal considerations such as socioeconomic component of rotavirus. Finland uses influenza vaccine. And Denmark might introduce flu vaccine to reduce the flu burden on the elderly.

* Ethics of consequentialist vaccine policy.

* Pandemrix Swine flu vaccine had an adverse effect event of narcolepsy (hundreds of children affected), Denmark was spared some of the consequence by limiting its recommendation to vulnerable children only.

* Flu deaths approximately 2-4/million, amongst children (Norway, US).

* Nordic countries were hesitant to recommend routine Covid-19 vaccination. Denmark admits it was a mistake to recommend vaccinating children (it was done for the adults and since the vaccine was leaky it made no difference, everyone got it anyway).

* Norway found in their pandemic investigation 6 weeks school closure was ‘a mistake’.

Key academic claims:

* Benn paper on Covid-19 becoming a childhood disease.https://www.bmj.com/content/374/bmj.n1687/rr-8 

* Benn: Predictably Covid-19 would be dangerous only to old, vulnerable, and those with a large viral inoculum.https://pubmed.ncbi.nlm.nih.gov/32146445/ and https://pubmed.ncbi.nlm.nih.gov/6741923/ 

* Benn: Non-trivial C19 Death amongst elderly, but it probably didn’t change the amount of years they lived. https://pubmed.ncbi.nlm.nih.gov/33137809/ 

* The greater the inoculum the more harmful the disease. Example: measles index cases v. https://pubmed.ncbi.nlm.nih.gov/6741923/ 

* Covid-19 harms, are rare in children. Actual risk to children prior to natural immunity and afterward (Ideally include all risks, Death, hospitalization, severe disease). ​​https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9613797/, risks of severe disease https://pubmed.ncbi.nlm.nih.gov/35962242/ 

* Even rare harms would outweigh the benefits of widespread childhood vaccination. https://www.bmj.com/content/374/bmj.n1687/rr-8

* Amongst most viruses the 2nd infection is less pathogenic.

* Harms of lockdown exceeded benefits in quality studies, some non quality studies might indicate otherwise. https://www.tandfonline.com/doi/full/10.1080/00779954.2020.1844786?src=recsys, https://www.tandfonline.com/doi/abs/10.1080/13571516.2021.1976051 

* Measles index cases (Child contracts the virus at school) results in more mild disease, family transmission is more severe with 4x fold mortality. https://pubmed.ncbi.nlm.nih.gov/6741923/ This has also been shown in animal studies https://pubmed.ncbi.nlm.nih.gov/36992457/. Epidemiological studies: Secondary cases (Family transmission) for Pertussis, https://pubmed.ncbi.nlm.nih.gov/11798255/ Varicella https://pubmed.ncbi.nlm.nih.gov/15702036/  and other viruses are worse than index cases i 

* Hoeg: MMWR School transmission of c19 is rare: https://www.cdc.gov/mmwr/volumes/70/wr/mm7004e3.htm 

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